Year 2021, Volume 5 - Issue 7

Background: The fall of serum sodium concentration may happen in hyperemesis gravidarum and subsequently can result into hypotonic hyponatremia. This would cause water to move into the brain and develop cerebral edema manifested with neurologic symptoms. However, adaptive mechanism by brain would lower the cerebral volume to a normal range. On the other hand, rapid correction of chronic hyponatremia would damage the brain cells. The symptoms depicted because of rapid over correction of sodium is known as osmotic demyelination syndrome. Case Presentation: The pregnant lady with hyperemesis gravidarum went to severe hyponatremia. And further, she underwent dilatation and evacuation because of the intrauterine fetal death. The normal saline administered to correct the state of hyponatremia caused the patient to be in depression with catatonia and aphasia. The symptoms were correlated with osmotic demyelinolysis and the event was confirmed with magnetic resonance imaging of brain. Conclusion: The administration of sodium should be performed with utmost cautions and under the supervision of welltrained healthcare providers. Any sign or symptom of neurological abnormalities observed because of overcorrection should be considered seriously.

Background: Mycosis fungoides (MF) is a rare type of non-Hodgkin’s lymphoma of T cells that primarily affects the skin. Radiation therapy is a cornerstone of therapy for all stages. Case Presentation: A 76-year-old man diagnosed in 2010 with MF in the patch/plaque phase (stage IB T2 N0 M0 B0) was treated with topical corticosteroids and successive sessions of photochemotherapy (psoralen and ultraviolet A) and phototherapy (narrowband ultraviolet B) with relative control of the lesional condition for 9 years. Due to the absence of clinical response and progression of the lesions, it was proposed for the treatment with radiotherapy. The patient underwent total skin electron beam therapy (TSEBT) (6 MeV electron/30/1 Gy per day/4 days per week). The patient showed marked improvement of the lesional condition with minimal toxicity. Remains in follow-up, with good control of the disease to date. Conclusion: MF is a challenging disorder from all perspectives. TSEBT in patients with extensive patches or plaques has an excellent response rate and rapid palliation.

Background: Photodynamic therapy (PDT) offers an effective treatment in several dermatological disorders. Herein, PDT has been assessed for the treatment of cutaneous leishmaniasis (CL) in a series of six patients from Pakistan. Cases Presentation: Six patients presenting with CL lesions at different face sites (i.e., cheek, nose, and lip) were treated with methylaminolevulinate-based PDT. The treatment was completed in three sessions, where a light dose of 75 J/cm2 was delivered through a low power (300 mW) red laser (wavelength = 635 nm) in each session. Results: The assessment of the disease at 10 months follow-up illustrated complete response in 5 patients, while partial response in 1 patient. Conclusion: This case series study demonstrated that PDT may offer a viable treatment option to the CL patients.

Background: Peripartum cardiomyopathy (PPCM), like spontaneous coronary artery dissection (SCAD), is a disease that affect healthy women and occur in the days before and after delivery. Case Presentation: We discuss the case of a 26-year-old woman, already a mother of a boy, who gave birth to two healthy twin girls by cesarean section. Two hours after delivery, the woman suddenly developed acute dyspnea and chest pain, which had angina pectoris features and was permanent. Her electrocardiogram showed sinus tachycardia at 125 beats per minute, with no specific ST segment deviation at 12 precordial (on the ECG), but also right and posterior leads. Echocardiography showed a significant reduction in left ventricular systolic performance, with an estimated LVEF (Left Ventricular Ejection Fraction) of approximately 25%-30%, and significant hypokinesis in the mid-distal part of the interventricular septum and the apex of the left ventricle. Her blood examination revealed an increase in troponin-T high sensitivity (0.245 ng/ml), with a mild parallel increase in creatine phosphokinase, as well as the MB (isoenzyme of CPK, the most specific indicator for the myocardial infarction diagnosis) form (383 and 52 IU/l, respectively). The NT-pro BNP (N-terminal pro Brain Natriuretic Peptide) was mildly increased, too, at 1280 pg/ml. The chest pain remained until the next 36 hours when it gradually disappeared, as the dyspnea, too. She was completely recovered until the 10th day of hospitalization. The patient underwent coronary computed tomography angiography, which showed 0 Agatston coronary artery calcium score units. However, in the middle of the left anterior descending (LAD) artery, after the protrusion of the second diagonal branch, an eccentric 7 mm non-calcified lesion was observed, which caused mild stenosis (1%-24%). Conclusion: PPCM and SCAD are related to young healthy women and occur in the peripartum period. However, in some cases, their clinical picture may overlap, making the diagnosis challenging.

Background: Falciform ligament abscesses are uncommon. The few cases reported in the literature are associated with infectious or inflammatory conditions such as acute cholecystitis and omphalitis in pediatric patients. However, it has only been rarely described as a complication for some therapeutic procedures. Case Presentation: A 23-year-old female with primary portal vein thrombosis, portal hypertension, and gastric varices with a history of upper gastrointestinal bleedings. The last episode required cyanoacrylate injection. After administering the injection, septic emboli obstructed the splenic vein causing the recanalization and thrombosis of the paraumbilical veins. Therefore, an abscess formed within the falciform ligament. The treatment consisted of surgical drainage and antibiotics. Conclusion: Diagnosis of falciform ligament abscesses requires a high degree of clinical suspicion and vast knowledge of anatomy. It is important to recognize its pathophysiology and consider the possible differential diagnosis to offer the best approach and treatment for its underlying cause.

Background: In some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease 2019 [COVID-19]), an uncontrolled release of inflammatory cytokines is characteristic. COVID-19 and adult-onset Still’s disease (AOSD) have been included by some authors in the “hyperferritinemic syndromes.” Another hyperinflammatory syndrome (with variable features of Kawasaki disease) called multisystem inflammatory syndrome (MIS) has been described in patients who have had SARS-CoV-2 infection. Case Presentation: We present a previously healthy patient who developed hyperinflammatory reaction compatible with MIS; the clinical presentation is additionally compatible with AOSD, complicated with a mild myocarditis. The patient had a positive SARS-CoV-2 serology (immunoglobulins G and immunoglobulins M ), but multiple reverse transcription-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 on nasopharyngeal swab were negative or indeterminate, so we considered that it is possible that an asymptomatic SARS-CoV-2 infection could have been the trigger for Still’s disease. 24 hours after starting methylprednisolone treatment, the fever was resolved and symptoms improved over the next few days, with persistent arthralgias. Conclusion: Asymptomatic SARS-CoV-2 infection could trigger MIS with AOSD-like features.

Background: Treatment of locally advanced endometrial cancer in patients with transplanted pelvic kidney requires precautions because of its anatomical position next to target volumes. Case Presentation: We report a case of 42-year-old woman with a right renal transplant for 3 years diagnosed with endometrial cancer for which she underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Adjuvant Radiotherapy (RT) was planned through intensity modulated RT (IMRT) with 45 Gy in 25 fractions followed by vaginal brachytherapy (5 Gy × 2 sessions) . Planning with IMRT quantified a mean dose of 2 Gy and maximum dose of 10 Gy over the transplanted kidney. This dose was further reduced with a comparative plan of three-dimensional conformal RT (3DCRT), recording a mean dose of 1 Gy and maximum dose of 5 Gy to the transplanted kidney. 3DCRT plan was accepted and delivered. At 2-year follow-up, patient is disease free with normal renal function. Conclusion: In the presence of advanced techniques, 3DCRT is still a valid radiation technique to keep the critical organ dose under acceptable dose-volume constraints without compromising the target volume.